- Discussion:
- child abuse: child abuse occurs in 50-80% of children < 2 yrs w/ femoral frx;
- limb length inequality are seldom a problem since frx does not shorten excessively;
- acceptable reduction:
- in children younger than 2 yrs, shortening of up to 1-1.5 cm & angulation of 30 deg are acceptable;
- Radiographs: 
- Treatment:
- early spica cast is often possible, if there is an acceptable reduction;
- w/ an unacceptable reduction, consider a period of skin traction using modified Bryant's traction (thighs in 45 deg flexion and 30 deg abduction);
- both legs need to be placed in traction to stabilize the pelvis;
- contraindicated after the age of 2 yrs or w/ weight more than 25 lbs;
- deligent skin care is a requirement;
- union occurs in about 2 weeks;
- leg weakness and/or limp may persist for one year;
- in the report by Morris S, et al (2002), the authors undertook a study to assess their incidence and outcome;
- 7 patients from a total of 55,296 live births suffered 8 femoral fractures (incidence 0.13 per 1,000 live births);
- twin pregnancies, breech presentations, prematurity, and disuse osteoporosis were associated with the occurrence of a fracture;
- variety of treatment modalities were used, including gallows traction, spica cast, and Pavlik harness;
- all patients in this study, regardless of treatment, had a satisfactory clinical outcome, with no evidence of limb length discrepancy or angular deformity on follow-up;
- ref: Birth-associated femoral fractures: incidence and outcome.
Comparison of Pavlik Harness Application and Immediate Spica Casting for Femur Fractures in Infants.